Family & Children's Medicaid Change Notices

The Deficit Reduction Act of 2005 mandates that applicants for Medicaid who declare United States citizenship, except those who have received or are currently receiving Medicare or SSI, must provide or cooperate in obtaining documentation of U. S. citizenship and identity. Additionally, current Medicaid recipients who have never received Medicare or SSI must provide or cooperate in obtaining documentation of U. S. citizenship and identity at the first redetermination occurring after full implementation September 1, 2006.

During July and August, counties posted notices in English and Spanish alerting applicants and recipients to the new requirement. Also, all staff who determine eligibility for Work First, Special Assistance, and all other Medicaid programs informed the applicants/recipients (a/r’s) of the forthcoming requirement.

II. APPLICATIONS

A. Review the case record and all county records for citizenship and/or identity evidence the agency may have on file. If evidence is located, make a copy of the evidence documentation for the Medicaid file and clearly document where the evidence was located, the date the documentation was provided to the county, and what hierarchy code it falls in. If the date of receipt by the county is unknown, note the date the worker located the document.

B. If the applicant has the documents proving citizenship and identity, obtain them. Make copies of the original documents and document the record. Return any original documents to the recipient.

If documentation is needed, use the DMA-5097/DMA-5097s, Request for Information, to seek the documentation in the highest tier of hierarchy. Follow MA-3330, Citizen/Alien Requirements, for documenting the record.

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C. If it appears this information will not be received in the 45 day processing deadline, then ask for information from a lower tier. Continue to pursue the higher tier documentation. Try not to pend an application. However, pend the application if:

1. The citizenship/identity documentation is not yet received by the end of the 45 day processing deadline, and

2. All other eligibility requirements are met or the application is missing items approved for excluding time such as bills to meet a deductible, and

3. The applicant is trying in good faith to obtain the documentation or the county has not yet received a response to an inquiry from a source other than the client.

Pend the application with a “CID” entry on the Date Screen to exclude processing time when the application is pending receipt of citizenship and/or identity. (See EIS 2400, Application Processing.) Send a DMA-5098/DMA-5098s, Your Application is Pending. Pend up to six months.

D. If the applicant requests assistance in obtaining the documents or if the applicant has special needs such as a mental or physical incapacity, the county must help. The county department of social services (DSS) is responsible for obtaining the documentation when there is a fee involved in obtaining the information, such as birth certificates.

The birth certificate must be a certified copy or you must obtain a copy of the certified birth certificate. Vital Records requires an authorization from the recipient, parent or legal guardian to provide a certified copy to the county. Use MA-3330, Figure 11, U.S. Citizenship Documentation Birth Certificate Request.

The cost for a birth certificate from the County Register of Deeds where the applicant was born is $10.00. Birth certificates for births in any North Carolina county may be requested from the North Carolina State Vital Records, 1903 Mail Service Center, Raleigh, NC 27699-1903. The Harnett County Register of Deeds has a pilot program where statewide county requests may also be submitted. Mail requests to the Harnett County Register of Deeds, P.O. Box 816, Lillington, NC, 27546. Indicate on the envelope the request is for Medicaid citizenship documentation. The cost for a certificate from the State Vital Records or Harnett County Register of Deeds office is $15.00. The length of time to obtain the birth certificate from a county is at least 7-10 days and at least 6-8 weeks from the Harnett county pilot program or the State Vital Records. Instructions on obtaining a certified birth certificate are on the Vital Records web site, http://vitalrecords.dhhs.state.nc.us/vr/index.html.

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E. If information to obtain documentation is not received or the documentation request is returned as unable to confirm and all other efforts to obtain the documentation fail, deny the application for not providing necessary information to confirm citizenship and/or identity.

III. Redeterminations

A. Review the case record and all county records for citizenship and/or identity evidence the agency may have on file. If evidence is located, make a copy of the evidence documentation for the Medicaid file and clearly document where the evidence was located, the date the documentation was provided to the county, and what hierarchy code it falls in. If the date of receipt by the county is unknown, note the date the worker located the document.

B. If the recipient has the documents proving citizenship and identity, obtain them. Make copies of the original documents and document the record. Complete the redetermination. Return any original documents to the recipient. Follow MA-3330, Citizen/Alien Requirements for documenting the record.

If documentation is needed, use the DMA-5097/DMA-5097s, Request for Information, to seek the documentation in the highest tier of hierarchy.

C. If the recipient states he does not have documentation and is making a good faith effort to obtain the needed documents, document the record. Complete the redetermination. If all other eligibility requirements are met, use Special Review Code “Z” on the DSS 8125 to follow up on the status of obtaining the documents. Use the third month of the new certification period for the reminder date to ensure efforts continue to be made to receive documentation. A message will show on the Case Management Report to remind the worker citizenship and/or identity documentation is needed. (See EIS 4000, Codes Appendix.)

D. If the recipient requests assistance in obtaining the documents or if the recipient has special needs such as a mental or physical incapacity, the county must help. The county department of social services (DSS) is responsible for obtaining the documentation when there is a fee involved in obtaining the information, such as birth certificates.

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Mail requests to the Harnett County Register of Deeds, P.O. Box 816, Lillington, NC, 27546. Indicate on the envelope the request is for Medicaid citizenship documentation. The cost for a certificate from the State Vital Records or Harnett County Register of Deeds office is $15.00. The length of time to obtain the birth certificate from a county is at least 7-10 days and at least 6-8 weeks from the Harnett county pilot program or the State Vital Records. Instructions on obtaining a certified birth certificate are on the Vital Records web site, http://vitalrecords.dhhs.state.nc.us/vr/index.html.

E. If the county has requested but has not received citizenship and/or identity documentation and all other eligibility requirements are met, process the redetermination and use the Special Review Code “Z” as in III.C. above.

F. Counties are encouraged to work together when the a/r does not have the citizenship and/or identity documents and reports he was born in another county.

If the a/r was born in another state, how to obtain birth information from other states is located on most state’s web sites. The web site, http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm, provides links to other states’ Vital Records.

IV. CONTENT OF CHANGE

The following manual sections and forms are changed to reflect the mandated requirements.

A. MA-3205, Conducting a Face-to-Face Intake Interview

In addition to meeting all other criteria for Medicaid, the applicant must provide or cooperate in obtaining citizenship and identity documentation.

B. MA-3210, Verification Requirements for Applications

Another program’s evidence documenting citizenship and/or identity may be used.

Citizenship and identity are separate requirements from the age and name requirements. See MA-3345, Age/Name/Marital Status.

C. MA-3215, Processing the Application

When the applicant cannot provide documentation within the 45 day limit and all other eligibility requirements are met, pend the application until the documentation is provided.

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D. MA-3230, Eligibility of Individuals Under 21

Do not pursue documentation until the one year redetermination for automatic newborns. Title IV-E, H-SF, and special needs adoption children receiving Medicaid must have documentation of citizenship and identity in their Medicaid record. However, treat these children as recipients. Use hierarchy code 99 and Special Review Code “Z” to alert the worker to pursue documentation. Use the third month of the certification period for the date.

E. MA-3255, NC Health Choice

While applicants for North Carolina Health Choice are not required to provide citizenship and identity documentation, it is strongly recommended that counties obtain the documentation due to the movement of the children between programs. To be eligible for NC Health Choice the income must be 100% - 200% of the federal poverty level. An a/r who does not provide citizenship and/or identity documentation and has income less than 100% of the federal poverty level is ineligible for NC Health Choice.

F. MA-3330, Citizen/Alien Requirement and new MA-3330 Figure 10, MA-3330 Figure 11, and MA-3330 Figure 12

1. Acceptable documentation proving the applicant/recipient’s (a/r’s) U. S. citizenship and identity is in a hierarchy. Explore the highest documentation before moving to a lower level when obtaining citizenship documents. Applicant’s documentation must be received prior to approval. Recipient’s documentation is obtained at re-enrollment. If the recipient does not have the documentation required and all other eligibility requirements are met, Medicaid continues. If the applicant’s U.S. citizenship and identity has not been provided at the end of the 6 month pending period, and he has received emergency medical services, evaluate for emergency Medicaid.

2. Once citizenship and identity are documented, documentation does not need to be provided again, unless the documents are found questionable.

3. The policy and procedures for documenting alien status for qualified and non-qualified aliens has not changed. Aliens do not need to provide additional documents to demonstrate identity.

4. The citizenship and identity requirement does not apply to Presumptive Eligibility for the pregnant woman.

5. Current and former Medicare and SSI recipients are permanently exempt from the documentation requirements as citizenship and identity were handled by the Social Security Administration.

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6. Citizenship and identity may be confirmed through OLV using SDX for current and former SSI recipients and using SOLQ for current and former Medicare recipients. Confirm identity using SOLQ. The SOLQ must indicate the SSN given by the a/r was verified.

G. MA-3410, Terminations and Deletions

Ex parte reviews do not require citizenship and identity documentation until the next re-enrollment.

H. MA-3420, Re-enrollment

Obtain documentation of identity and citizenship at re-enrollment when it has not been previously obtained.

The duty to cooperate in seeking medical support also applies to caretaker only cases when the eligible child(ren) receives SSI unless the caretaker is pregnant.

I. The following forms are changed:

1. DMA-5096, Document of Need

2. DMA-5098/DMA-5098s, Your Application for Medicaid is Pending

3. DMA-5097/DMA-5097s, Request for Information, was previously changed to include citizenship/identity.

V. EFFECTIVE DATE and implementation

This change is effective September 1, 2006. Apply this policy to applications taken on or after September 1, 2006. For redeterminations, apply this policy to redeterminations started on or after September 1, 2006.

vI. MAINTENANCE OF MANUAL

A. Remove: MA-3205, Conducting a Face-to-Face Intake Interview, pages 3-4, 11-12, and MA-3205 Figure 4.

Insert: MA-3205, Conducting a Face-to-Face Intake Interview, pages 3-4, 11-12, and MA-3205 Figure 4 dated 9/1/06.

B. Remove: MA-3210, Verification Requirements for Applications, pages 1-7, MA-3210 Figure 2A and MA-3210 Figure 2B.

Insert: MA-3210, Verification Requirements for Applications, pages 1-7, MA-3210 Figure 2A and MA-3210 Figure 2B dated 9/1/06.

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C. Remove: MA-3215, Processing the Application, pages 1-8.

Insert: MA-3215, Processing the Application, pages 1-8 dated 9/1/06.

D. Remove: MA-3230, Eligibility of Individuals Under 21, pages 3-18, and 21-22.

Insert: MA-3230, Eligibility of Individuals Under 21, pages 3-18, and 21-22, dated 9/1/06.

E. Remove: MA-3255, NC Health Choice, pages 1-2.

Insert: MA-3255, NC Health Choice, pages 1-2 dated 9/1/06.

F. Remove: MA-3330, Citizen/Alien Requirement, pages 1-31.

Insert: MA-3330, Citizen/Alien Requirement, pages 1-39 dated 9/1/06, new MA-3330 Figure 10, MA-3330 Figure 11, and MA-3330 Figure 12.

G. Remove: MA-3410, Terminations and Deletions, pages 3-4.

Insert: MA-3410, Terminations and Deletions, pages 3-4 dated 9/1/06.

H. Remove: MA-3420, Re-enrollment, pages 1-10.

Insert: MA-3420, Re-enrollment, pages 1-10 dated 9/1/06.

If you have any questions, please contact your Medicaid Program Representative.

L. Allen Dobson, Jr., M.D., Assistant Secretary

for Health Policy and Medical Assistance

(This material was researched and written by Susan Ryan, Policy Project Manager, Medicaid Eligibility Unit.)

For questions or clarification on any of the policy contained in these manuals, please contact your local county office.